| Boodah, Inc | |
|
161 Summer St Ste 5 Kingston MA 02364-1275 | |
| (800) 593-2560 | |
| (800) 593-2560 |
| Full Name | Boodah, Inc |
|---|---|
| Speciality | Psychologist |
| Location | 161 Summer St Ste 5, Kingston, Massachusetts |
| Authorized Official Name and Position | Collen Long (OWNER/PROVIDER) |
| Authorized Official Contact | 8005932560 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boodah, Inc 161 Summer St Ste 5 Kingston MA 02364-1275 Ph: () - | Boodah, Inc 161 Summer St Ste 5 Kingston MA 02364-1275 Ph: (800) 593-2560 |
| NPI Number | 1104390525 |
|---|---|
| Provider Enumeration Date | 01/18/2019 |
| Last Update Date | 01/18/2019 |
| Medicare PECOS PAC ID | 8224361332 |
|---|---|
| Medicare Enrollment ID | O20190605000184 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104390525 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Cynthia A Pearson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740568096 PECOS PAC ID: 0244405660 Enrollment ID: I20111214000386 |
| Provider Name | Ryan M Gazzola |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477760775 PECOS PAC ID: 9335365469 Enrollment ID: I20140728000259 |
| Provider Name | Colleen Long |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558662445 PECOS PAC ID: 4183895741 Enrollment ID: I20160711001162 |
| Provider Name | Anya Woronzoff Verriden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871072371 PECOS PAC ID: 5597172403 Enrollment ID: I20210320000016 |
| Provider Name | Lauren Powell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285304980 PECOS PAC ID: 9436548708 Enrollment ID: I20211109000395 |
| Provider Name | Desreen Nichole Dudley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841635786 PECOS PAC ID: 6305088675 Enrollment ID: I20220502001546 |
| Provider Name | Jennifer Anne Benger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346729514 PECOS PAC ID: 0042648008 Enrollment ID: I20220503002581 |
| Provider Name | Gwyne White |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861088312 PECOS PAC ID: 2365808508 Enrollment ID: I20230515001222 |
| Provider Name | Leah Sciaba |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578751897 PECOS PAC ID: 0648633396 Enrollment ID: I20230828003228 |
| Provider Name | Catherine Smail |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821422304 PECOS PAC ID: 3779920905 Enrollment ID: I20240325000852 |
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